Schafer: Exchanges have been tried, and worked

Champions of health insurance exchanges like the brand-new MNsure say that buying coverage will be as easy as booking travel on Orbitz.com.

That might be true — if you fly to Seattle by way of Budapest, São Paulo and Tokyo. Not that much is simple about health insurance in 2013.

A better comparison than Orbitz is right here in the Twin Cities, and it’s called My Plan by Medica. It’s not like a health insurance exchange. It is one.

If Medica’s two years of experience with My Plan is any guide, consumers will find their way around MNsure and buy insurance, and then happily come back next year when it comes time to renew.

Just to be clear, My Plan by Medica is not an insurance plan, just as MNsure is not an insurance plan. Both are places where people go to shop for insurance.

What makes My Plan a private exchange, and different from MNsure, is that its 20 plans are all versions of products offered by Medica, the big health plan company based in Minnetonka, and any user has to first go through his or her employer.

But those 20 options on My Plan look to be a pretty fair representation of what’s available here in the Twin Cities, all aligned side by side to compare by price and features. There’s even a little head-to-head competition on the My Plan exchange from four health care providers that have each offered a version of what’s called an accountable care organization.

My Plan launched in summer 2011, and the way it works is an employer signs up for My Plan and provides materials to its rank-and-file. A link to My Plan’s website gets sent to employees. They then sit down at the family computer, spark up a browser and go shopping for a medical plan.

Those of us who aren’t actuaries can find shopping among 20 plans a very daunting task, and that’s particularly true for folks who have never had to do it before.

That’s why, said John Naylor, Medica’s senior vice president, commercial markets, “you have to give them a life preserver, to help them make an informed choice.”

Naylor said MNsure is trying to help consumers make good decisions by “tiering” its choices. For My Plan, Medica elected to have users start the process by filling in an online survey it calls a “decision support tool.” It asks more than 30 questions about a member’s situation in an easy-to-understand, conversational style, looking for everything from health status to an appetite for financial risk. It takes about 10 minutes to complete, and then the system will recommend three plans that appear to meet a member’s goals.

Members not comfortable with any part of the process can phone a Medica staffer, much like consumers can call a MNsure service rep. Naylor said perhaps a third of My Plan’s members will call at least once, and some just want to run their decision by another person before clicking “buy.”

Consumers at My Plan, Medica has found, can be price-conscious shoppers. Many have opted for a health savings account combined with higher deductible insurance. More than 40 percent of those who have the option chose one of the ACO plans, so-called “narrow networks,” which means they agree to get care only from Park Nicollet or another of the providers in the program.

These narrow network plans are not that much cheaper than comparable open-access plans, but with a fixed amount provided for insurance by an employer, all of the savings benefit the individual, not the employer.

There’s a downside to choosing a narrow network, of course, which a person will discover the day he or she goes to see a specialist outside of the network. But at least the consumer made that call and not the human resources director at work.

Naylor had a hard time coming up with any disappointments in My Plan’s short life, noting that all of the clients from the first year renewed. If asked to pitch just one lesson, he answers this way: “Employees value choice. For generations they’ve been told, ‘Here’s your medical plan.’ And one size doesn’t fit all.”

Employers report that their employees have come to like the exchange — after getting up to speed on a totally new way of receiving health benefits.

“We had a lot of people change plans, which is great,” said Michelle Murray, the manager of benefits for Hubbard Broadcasting in St. Paul and an early client of My Plan. “That shows the power of choice. I think we had 25 percent of our people change plans.”

Employers have told Naylor that their employees in the plan aren’t just interested in spending less on premiums, they are becoming far more interested in keeping healthy. Some, for example, have been asking their employers for more and better workplace health and wellness programs.

Are previously uninsured Minnesotans going to find MNsure as easy to navigate as Hubbard’s employees found My Plan? Probably not. There are plenty of differences here, too, not least of which is that My Plan was created by a private health insurer in a group health insurance market that is beat-each-other’s-brains-in competitive.

But My Plan and MNsure are more alike than not, and My Plan’s story shows consumers figuring out how to shop for insurance on an exchange. When they do, they become more interested in keeping healthy than they were, more aware of what health care really costs and more interested in finding lower-cost options.